Most medical practices signed their initial commercial payer contracts on whatever terms the payer offered, then never re-negotiated. Fee schedules drift. New CPT codes get reimbursed below market. Multi-year escalators that should have triggered didn’t get applied because nobody read the contract since 2019. PPS does fee schedule analysis and payer renegotiation. We pull your contracts, model what you’re being paid versus market benchmarks for your specialty and region, and run the renegotiation conversation with the payer’s provider relations team.
What’s included
- Contract inventory and audit — every commercial payer agreement you’ve signed, what fee schedule it references, what’s expired.
- Fee schedule analysis — your top 20 CPT codes by volume, modeled against market benchmarks for your specialty and region.
- Renegotiation strategy — which payers have leverage, which have flexibility, which are bottom-of-market and need to be questioned.
- Provider relations outreach — we run the conversation. You don’t have to.
- Amendment review — when the payer comes back with a counter, we read it carefully for the language that quietly takes back what they just gave.
- Implementation tracking — confirming the new fee schedule actually shows up in claims paid.
How it works
Weeks 1-3. Contract pull, fee schedule modeling, opportunity-sizing report. You see the numbers before deciding which payers to renegotiate.
Weeks 3-12. Renegotiation conversations. Some close quickly. Some require multiple cycles.
Weeks 8-16. Amendment review and implementation confirmation.
The honest reality: not every renegotiation lands a raise. Payers say no. But the analysis itself is worth doing because it tells you which contracts are losers — and whether you should consider going out-of-network with a payer entirely.
Who this is for
- Established groups (3+ providers) who haven’t reviewed payer contracts in 3+ years.
- Practices considering whether to drop a low-paying payer.
- Practices going through a merger or acquisition where contracts need to be consolidated.
- Specialty practices whose case mix has shifted and whose top CPTs aren’t the ones the contract was modeled around.
What we won’t promise
We won’t promise a percentage raise. Anyone who promises that is either lying or pricing it into the engagement fee. We’ll tell you the realistic upside before you commit, based on the contract audit.
Get started
Send us your top 3 payer contracts and your top 20 CPTs by volume. We’ll do an initial analysis and quote scope from there.
Start a contract analysis — or pair this with Revenue Cycle Management for combined contract + billing optimization.